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Describe Dobutamine drug
- 1.Positive inotrope
- 2.increases cardiac output w/o increasing O2 demand of the heart
- 3. Helps contractility
- 4. diuretic-vasodilator
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Describe Nitropusside (Nipride)
- 1. Dilates veins & arteries
- 2. Decreases cardiac workload
- 3. Decreases preload & afterload
- 4. Decrease systemic, hypertension →
- hypotension ↓ cardiac output
5. light sensitive
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Treatments for CHF
Diuresis or improve contractility
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The drug that gets rid of extra fluid
diuretic drug...Furosemide (Lasix)
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The drug that decreases angiotensin II and aldesterone and has a dry non-productive cough as a side effect
ACE inhibitor
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The drug that slows the heart allowing more time for the heart to fill
Beta-blocker
- propranolol
- acebutolol
- atenolol
- metoprolol
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The drug that decreases both preload and afterload by vasodialtion
Nitroprusside (Nipride)
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The vessels known as the capitance vessels and regulate preload
venules
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An endogenous substance and is a potent vasocontrictor
Angiotensin II
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The preferred treatment for hypertension
Life style change
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The blood pressure =
CO x TPR
TPR= Total peripheral resistance across systemic circulation
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Na channel blocker
Prevents depolarization and ↓ excitability and contraction outside the SA node
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Describe Beta-blocker
- Class II drug
- ↓ HR, Conduction, BP and O2 consumption of the heart
- ↑ filling time better contractility & force output
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Describe Amiodarone drug
Prolongs re-polarization but has serious side effects of pulmonary fibrosis
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Supraventricular
Arrhythmia that originates above the ventricles and include afib & aflutter
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What is the normal electrical pathway of the heart?
SA node → AV node → Bundle of HIS → Bundle branches → perkinjie fibers
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Aspirin used for
A cardiac drug for its anti-platelet aggregation properties
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Heparin is used for
Anti-coagulant that can only be given via injection
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Warfarin is used for
Anti-coagulant that inhibits vitamin K and is given orally
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Streptokinase or Urokinase is?
Thrombolytic is injected directly into the coronary arteries to dissolve a clot and managment of AMI
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Epinephrine drug
- 1. Drug used to make the heart more susceptible to shocks.
- 2. Improves the likelihood of converting ventricular fibrillation and tachycardia to rhythms with spontaneous circulation.
- 3. Improves cerebral blood flow.
- 4. Increase rate and force.
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Atropine drug
- Keeps the heart rate stable
- Does not increase the HR and prevents it from decreasing
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Sodium bicarb given when?
Only given in a code when the patient has metabolic acidosis, hyperkalemia or DO
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Blood flow through the heart:
Rt Atrium → Rt Ventricle →Pulm artery→Pulm Vein→Lft Atrium→Lft Ventricle
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Depolarization
- -The process of potassium moving out of the cell and sodium moving in → causes contraction.
- -Resting: Potassium moves back in sodium moves out.
- -Calcium needed for muscle contaction
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Optimal peep
Decreasing peep at 2cm intervals until there is a decline in O2 delivery.
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Positive pressure ventilation =
- ↓ CO because of alveolar pressures ↑ intrathoracic pressure ↓ venous return. ↑ Alveolar pressure stretches and narrows the capillaries that surround the alveoli =
- ↑ PVR →overdistention of the rt ventricle (backs up) cor pulmonade ↓ Lft ventricle output
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Trachea stenosis
Narrowing of the lumen of the trachea
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Tracheomalacia
Softening of the tracheal rings that collapse upon inspiration.
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Humidification temperature should be
32-35 degrees Celsius
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Anion Gap
9-14 mEq/L normal value
+14 fixed acid problem
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Pulmonary Capillary O2 content equation
CcO2=(Hgx1.34) + (PAO2x0.003)
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Carrying of blood to the tissues in the pulmonary arteries equation
- (Hgx1.34xSaO2) + (PaO2x0.003) = CaO2
- Hg + Plasma
Normal value 16-20ml/dl
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Intrapulmonary shunting
Cause of ventilatory failure
- Perfusion in excess of ventilation, wasted perfusion, atelectasis
- Causes refractory hypoxemia: Healthy <5%
- Non critical <10% Critical >30%
- 10-20% Mild, 20-30% sig. shunt
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Diffusion A-a gradient
PAO2=(760-47)FiO2-PaCO2/1.25 (.8)
Normal 5-10
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RAW normal airway resistance
0.6-2.4cmH2O/L/Sec @ a flow rate of 30L/min
In mechanical ventilation RAW is primarily affected by the length, size and patency of the airway, endotracheal tube, and ventilator circuit
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Hypoxemia values
- 80-100 mmHg Normal
- 60-79 mmHg Mild
- 40-59 mmHg Moderate
- less than 40 mmHg Severe
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Hypoventilation
- Cause of ventilatory failure
- Reduction of alveolar ventilation ↑ PaCO2
- PaCO2 >45mmHg
- >50mmHg COPD pt.
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Venous Blood Gases
- 7.30-7.40 pH
- 42-48 PaCO2
- 24-30 HCO3
- 35-40 VO2
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CHF
- Loss of contractility or pump efficiency ma the blood volume increase within the heart.
- ↓ Efficiency ↑ Afterload pumps against resistance can't empty
- ↑ Volume hypertrophy CO↓ blood flow to kidneys ↓ dehydrated, hypovolemic kidneys retain fluid - backs up t/o body
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